Background: Nocturnal and early morning hypertension are both significant risk factors for cardiovascular events. It remains unclear whether anxiety disorder affects nocturnal blood pressure (BP), early morning BP, or BP pattern in hypertensive patients. Methods and Results:One hundred and twenty consecutive hypertensive outpatients (77 men and 43 women; mean age, 66±11 years) were divided into 2 groups based on Hospital Anxiety and Depression Scale (HADS) score: a control group (n=78; HADS ≤10) and an anxiety group (42 patients; HADS ≥11). Nocturnal BP, early morning BP, morning BP surge (defined as BP rise ≥50 mmHg), and BP pattern (extreme-dipper/dipper/non-dipper/riser) were measured on ambulatory BP monitoring. Clinical characteristics and BP were also evaluated at physician check-up. There was no significant difference between the 2 groups for BP check-up, but nocturnal and early morning BP were significantly higher in the anxiety group (142±16 mmHg and 152±21 mmHg) than in the control group (126±14 mmHg and 141±18 mmHg). With regard to patients with morning BP surge, nocturnal and early morning BP were also significantly higher in the anxiety group. The relative risk of existing anxiety disorders in riser-type hypertension was 4.48-fold higher (95% confidence interval: 1.58-12.74; P<0.005) than in dipper-type hypertension. Conclusions:Anxiety disorder is associated with nocturnal and early morning hypertension, and may be a risk factor for cardiovascular events. (Circ J 2012; 76: 1670 - 1677

ype 2 diabetes mellitus (T2DM) increases the incidence of cardiovascular events (CVE) and is a major cause of heart failure (HF). 1 Left ventricular (LV) diastolic dysfunction, a process that occurs independently of CVE in T2DM, is known to exacerbate HF. 1,2 Three recent large-scale randomized control trials (RCTs) have reported that sodium-glucose cotransporter-2 inhibitor (SGLT2-i) reduces all-cause mortality, cardiovascular mortality, and rehospitalization for HF in T2DM patients during the 6 months. 3-5 Previous studies failed to show that other antidiabetic drugs reduced CVE. 6 The mechanisms underlying the HF benefit from SGLT2-i are likely multifactorial effects involving rapid changes in body composition, systolic blood pressure (sBP) and heart rate (HR), including reduced cardiac preload and afterload, and improvement in LV diastolic function on echocardiography. 3,7-12 HF is clinically characterized by dyspnea or shortness of breath that can be displayed at rest or with exertion. Exercise-

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This study was conducted to determine the effects of depression and/or insomnia on masked hypertension (MHT) compared with other types of HT and on variability in home-measured blood pressure (HBP) and clinic BP (CBP). Three hundred and twenty-eight hypertensives (132 women) aged 68±10 years were classified into four BP types: controlled HT (CHT), white-coat HT, MHT and sustained HT (SHT), based on CBP (140/90 mm Hg) and morning HBP (135/85 mm Hg) measurements. A score of ⩾16 on the Center for Epidemiologic Studies Depression Scale (CES-D) was defined as depression. The mean values and s.d. of BP were calculated from measurements taken during the 14 consecutive days just before the CES-D evaluation. Compared with the CHT group, the risk of depression was 2.77-fold higher in the SHT group and even higher in the MHT group (7.02-fold). The association between depression and MHT was augmented in the presence of insomnia and was somewhat stronger in women. A HBP variability index defined as s.d./mean BPs in both morning and night time was significantly higher in MHT than in the other BP types, whereas that of CBP was not. Both morning and night-time HBP variability were significantly higher in depressive patients than in non-depressives. These suggest that depression is associated with MHT and that increases both morning and night-time HBP variability but not CBP variability. Physicians should be mindful of mental stresses such as depression in their hypertensive patients when forming strategies to control BP over the diurnal cycle.

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